痈疽发背怎生医，不论阴阳先灸之，不痛灸至痛，疼灸不痛时。
凡看痈疽脑项等发大疮，先要从容立定主意，以见标日期为始，到今几日，看疮形
与日期可否相对，相应则多吉，不应则多险。次看受病之源，发于何脏腑，出于何部位。但
身体有上下，部位有险否，形色辨顺逆，精神论有无。再看年纪老壮，气血盛衰，发阴
发阳，毒深毒浅。以阳为易治者多生，以阴为难治者多死。方诊脉之虚实，可知顺险，以
决其终。凡疮未溃前，脉要太过一二至，已溃后，又宜不及二三分，此为脉病相应，首
尾自无变症。如其相反，恐防不测，但看法全在目力精巧，与心相应，一一参明，表里
透彻，然后方定治法。凡疮七日以前，情势未成，无气未弱，不论阴阳表里，寒热虚实，
俱先当灸。轻者使毒瓦斯随火而散，重者拔引郁毒，通彻内外。火引毒瓦斯混合为阳，方能
发肿作痛，然后可汗可攻，或消或托，兼求标本忝治，必以脉合药以药合病，如此治之，
自然无错矣！故药难执方，全在活法，大抵关节首尾，俱不可损伤元气脾胃为要。
内服蟾酥丸一服，外将神火照三枚。
凡疮初起，七日之前，或已灸之后，未服他药，宜用蟾酥丸一服，得汗解为妙。或
万灵丹发汗亦可，所谓毒瓦斯随汗而散，最为
快捷方式。如二药服后，发汗不出，此乃表里闭密之故，毒亦不轻，当神妙拔根方施治。神
灯照法，亦不可用之太早。如疮四五日之间，形未聚，毒未出，若早用之，恐留郁在内，毒
反难出。须用在八九日之后，疮势已定，毒瓦斯已聚，未成脓腐之时。用此照之，已成者
自高，未成者自消，不溃者自溃，不脱者自脱，亦且解毒活血消肿散瘀之良法也。
用膏贴顶上，敷药四边围。
凡疮最忌风寒所袭。初起之时，或已灸之后，俱当用太乙膏盖贴顶上，功效在于拔
毒，提顶提脓，防御风寒不入。如 痛高肿，阳疮七日之后，疮头自有黄色，稠脓相粘膏
上，余肿红色光亮鲜明，每日宜用葱汤洗净，换膏贴之。其正脓定在十一日前后出也，此
为易治易安之症。如七日之后，疮不大肿高，四边又不 痛，疮头亦无脓意相粘，此为阴
阳相等之症。宜用化腐紫霞膏，涂疮顶上，外以膏药盖之。换至十日外，疮顶渐腐，余肿
渐高，似有脓意之象，其正脓只在十五日之后可出也，此为以险成顺之症。至于二十日
以后无脓者，乃纯阴之症，纵治亦无效矣。又如疮之四围根脚余肿，其功又在敷药，收束
根本，庶不开大。初起时宜用金黄散敷于四边，拔毒消肿止痛。既溃后，当用铁桶膏箍
之，庶疮根渐收渐紧。但诸疮原因，气血凝滞而成，切不可纯用凉药，冰凝肌肉，多致
难腐难敛，必当温暖，散滞行瘀，拔毒活血药用之，方为妥当也。
气盛兮顶自高而突起，血盛兮根脚束而无疑。
气血者，人之所原禀。老者尚或有余，少者亦有不足。人之命脉，全赖于此。况百病
生焉，失此岂能无变，独疮科尤关系不浅。但肿疡时，若无正气冲托，则疮顶不能高肿，亦
不能 痛溃脓，则无真阴相滋，疮根不能收束，色亦不能红活收敛。凡疮顶高根活，不
论老少，气血有余，俱可无妨。又宜交会明白，交会者，疮根与好肉交界之处，高低自
然分别；明白者，疮形与好形，各无混杂。以此观之，了然明白矣。
高肿起者，忌用攻利之药，以伤元气。平塌漫者，宜投补托之剂，以益其虚。
凡疮初发高起者，五内原无深毒，毒发于表，便得托里，以速其脓，忌内消攻伐，以
伤脾气，脓反难成，多致不能溃敛。又疮初起不高不赤，平塌漫者，元气本虚，急宜托
里温中健脾，催托毒瓦斯外发。庶无变症矣。
内热甚者，量加消毒清剂。便秘燥者，必须通利相宜。使脏腑得宣通，俾气血自流利。
肿疡时内热口干，脉实烦躁，便秘喜冷者，此为邪毒在里，急与寒凉攻利，宜内疏
黄连汤，四顺清凉饮，内消沃雪汤，俱可选用。又兼有表症，防风通圣散，去麻黄，或
双解散，加桔梗，天花粉，又或小便不利者，兼入天水散，五苓散，俱可合用。务使二便
通利，以杜其源。又有元气素虚者，恐不胜前药，以托里消毒散，加蜜炒大黄，或兼猪
胆导法，必得通利为度。首尾俱要闭而不结，通而不泄，得脏腑和平，表里透彻，方可托
里排脓。内补之药，又如溃疡时，虽有口干便闭，脏腑不和不利等症，此因溃后脓水出
多，内亡津液，气血虚耗，不能荣润脏腑所致。其人必脉细而数，口和而干，饮食减少，
好饮热汤，此乃虚阳之火为病，非前有余可比。只宜养气血，滋津液，和脏腑。如此治
之，则二便自和，亦无变症。常有误行攻利，多致不救者矣。
十日之间疮尚坚，必用披针，当头点破。
凡疮十日以后，自当腐溃为脓，如不作脓腐，仍尚坚硬者，此属阴阳相半之症，疮
根必多深固，若不将针当头点入寸许，开窍发泄，使毒瓦斯无从而出，必致内攻也。倘内
有脓，又便易出，此为开户逐贼之意也。亦有十日外，疮虽不腐溃，形尚红活， 热肿
痛，此虽脓迟，后必有出，此又不必针之。盖缘元气不能充足，或失用补托之药，又误用
寒凉，或盖覆未暖，多致脓迟。有此症者，宜
用补中健脾，大补托药，以得脓为效。又以十五日至二十一日为期，过此外者，纵有稀
脓，但元气被毒相拒，日久必致耗散，诚难归结也。
半月之后脓亦少，须将药筒，对顶拔提，有脓血之交粘，必腐肉之易脱。
如疮半月后仍不腐溃，不作脓者，毒必内陷，急用披针品字样，当原顶寸许，点开
三孔，随疮之深浅，一寸二寸皆可入之，入针不痛，再深入不妨，随将药筒预先煮热，对
孔窍合之良久，候温取下。如拔出之物，血要红而微紫，脓要黄而带鲜，此为血气营运
活疮，其人必多活。又谓脓血交粘，用药可全，色鲜红活，腐肉易脱。如拔出瘀血紫黑，
色败气秽，稀水无脓者，此为气血内败死疮，所谓气败血衰，神仙欢哉。此等之疮难矣，其人必在月终亡。
且如斯时，内有脓而不得外发者，以针钩向正面钩起顽肉，用刀剪，当原顶剪开寸
余，使脓管得通流，庶疮头无闭塞。
已用药筒拔脓之后，外既有孔，内窍亦通。疮期又当大脓发泄之后，如脓尚少，亦
非自然得出，故疮头必有瘀腐涂塞，内肉亦有顽膜阻隔，多致脓管不通，自难出也。须
用针钩起疮顶顽肉，以披针利剪，随便取去寸余顽硬之肉，取之微痛血出，俱自不妨，随
用两手轻重得宜，从疮根 处，渐渐捺至中间，剪出脓管处，内有聚脓，自然涌出，以
黄色稠浓为吉，其脓日渐多者为轻，反此为虑。此功务使涂塞者开之，令脓毒外发也。
频将汤洗，切忌风吹。
凡疮未溃前，或已用照药后，俱要煎葱艾汤每日淋洗疮上一次，甚者早晚二次，使
气血疏通，易于溃散。又已溃时，及药筒提拔之后，尤宜避风，先去旧药，用方盘疮下
靠身放定，随用猪蹄汤以软绢淋汤疮上，并入孔内，轻手捺净内脓。庶败腐宿脓随汤而
出，以净为度，再以软帛叠成七八重，勿令太干，带汤覆于疮上，两手轻盈旋按片时，帛
温再换，如此洗按四五次，使气血得疏通，患者自然爽快，毒瓦斯得解，腐肉易脱，疼痛得
减，此手法之要，大疮不可缺也。候腐脱已见红肉时，洗后随用红玉膏挑于手心捺化，搽
新旧肉上，外用膏盖，四边根脚已消，不必箍药，每日如此，不数日，脓尽腐脱，新肉
顿生。再加内补，调理得宜，轻疮只在月余，大疮不过七十日，必完口而愈。
关节在于斯时，变生出于此候。
关节者，阳疮以十四日为关，阴疮以二十一日为节，此时务要出脓势定，不可过酿。
但脓出方自腐脱；腐脱方自肌生，肌生方自收敛，收敛方自疮平。如斯时不得脓者，后
必有变，为一关顺，后必多顺，一关逆，后必多逆。
治当大补，得全收敛之功，切忌寒凉，致取变生之局。
凡疮溃后，五脏亏损，气血大虚，外形虽似有余，而五内不足，法当纯补，乃至多
生。已溃时发热恶寒，脓多自汗作痛者，十全大补汤。虚热少睡，饮食不甘者，黄 人
参汤。皮寒虚热，咳嗽有痰者，托里清中汤。四肢倦怠，肌肉消瘦，面黄短气者，人参养
荣汤。脓多心烦，少食发躁不睡者，圣愈汤。脾亏气弱，身凉脉细，大便溏泄者，托里温
中汤。饮食不甘，恶心呕吐者，香砂六君子汤。脾虚下陷，食少虚热间作者，补中益气
汤。肾虚作渴，不能相制心火者，加减八味丸。仿此选用，盖托里则气血盛而脾胃旺，使
脓秽自排，毒瓦斯自解，死肉自去，新肉自生，饮食自进，疮口自敛。若不务补托，而误用
寒凉，谓之真气虚而益虚，邪气实而益实，多致疮毒内陷，脓多臭秽，甚则脉洪大渴，面
红气短，此真气虚而死矣。
盖疮全赖脾土，调理必要端详。
脾为仓廪之官，胃为水谷之海。胃主司纳，脾主消导。一表一里一纳一消，营运不
息，生化无穷。五脏六腑，借以生养，又谓得土者昌，失土者亡。盖脾胃盛者，则多食
而易饥，其人多肥，气血亦壮；脾胃弱者，则少食而难化，其人多瘦，气血亦衰。所以命
赖以安，病赖以安，况外科尤关紧要。善养脾胃者，节饮食，调寒暑，戒喜怒，省劳役。
如不然，则精神气血由此而日亏，脏腑脉络由此而日损，肌肉形体由此而日削，所谓调
理一失，百病生焉，故脾胃不可不详也。
冬要温床暖室，夏宜净几明窗。
人之气血，喜暖而恶寒，又谓遇寒则结，遇热则散。况疮乃肌肉破绽之病，若不防御，
风寒最为易袭。凡看疮时，冬要围炉暖室，逼尽余寒。夏宜净几明窗，庶外风不入，然后
方可揭膏洗贴。
饮食何须戒口，冷硬腻物休飧。
人之病中，肿痛时自然痛伤胃气，诸味不喜。直待溃后，脓毒一出，胃气便回，方
欲思食。彼时但所喜者，便可与之，接补脾胃。如所思之物不与，此为逆其胃气，反致
不能食也。切要不可太过，惟恐生冷伤脾难化，硬物肥腻滑肠，故禁之。
痈疽虽属外科，用药即同内伤。
古之以外科推为杂病之先，盖此伤人迅速，关系不浅，故特设于前也。且如痈疽脑
项疔毒大疮，情势虽出于外，而受病之源，实因于内也。及其所治，岂可舍于内而治外乎？
所以外不起者，内加托药；表热甚者，内必清解。血虚宜用四物汤，气虚宜用四君子汤，
脉虚足冷温中，脉实身热凉膈。以此推之，内外自无互异。
病要论久新，要法在于宽治猛治。
病有新久，势有缓急。如受病之初，元气未弱，治当随症迎刃而解。若惧行霸道猛
剂，定不能决效于危急时也。用药中病，如表症盛者，用万灵丹，大加表散。里症急者，
以内疏黄连汤，急与通行。又如受病日久，邪正相拒，其元气示有不衰弱者，纵有余症杂
症壤症，俱当先固其本，而后调之和之散之，使病气渐退，元气渐醒，饮食渐进，根本渐
实，则余患再无不愈之理。
药必求标本，功莫别于先医后医，若一概之攻补，恐两途之误用。
物理皆有标本。而病之标本，尤莫切焉。身体之标本，五脏为本，六腑为标。五脏主里主血，六腑属表
属气。疾病标本，以初病为本，以传病为标；又以元气为本，病气为标。此所以寒热表里缓急之病，应汗下补
泻和解之方。凡治病者，必先治其本，后治其标。若先治其标，后治其本，使邪气滋甚，其病益增。又谓缓则
治其本，急则治其标，假如先得疮疾，而后得泄泻呕吐食少等症，宜舍本从标之法治之，候泻止呕定食进，方
再治疮，余皆仿此。
又说阳变为阴，内外被寒凉克伐。
疮本发于阳者，为痈为热为实为疼，此症易治。患者不觉，以为小恙，不早求治。反
又外受风寒，内伤生冷，或再被医者失于补托，而又以凉药敷围，以图内消，合病家之
意，多致气血冰凝，脾胃伤败，使疮毒变在十一日未出脓之前，情势与好肉相平，不疼
不热，软慢相兼，疮孔止流清稀肥水，更兼身体不热，脉亦细微，饮食厌飧，精神昏短。
有此症者，变入真阴，虽强投温中健脾之剂，不应者，百无一生。如疮变在十五日之后，已
出脓时，毒瓦斯已将外发，如有调摄失宜，误食冷物，忽变为阴者，急投托里温中汤，十
二味异功散，轻者十全大补汤，俱倍加参 桂附以救之。须得疮热作痛，脓出身温，脉
起食进者为吉。但疮原本于阳其人故得多生者有矣。
岂期阴变为阳，首尾得辛热扶衰，病分真似，理究阴阳。
疮本发于阴者，为疽为冷，为硬为虚，此症难治。患者知觉欲生，而故将辛香酒煎大
方热药以助之，医者又欲患处高肿， 热作脓，敷以热药，图其起发，故疮得药性大热，
转阴为阳。其疮虽得微肿微热微痛微脓，但疮形终不似真阳红活，不得真浓黄脓，如此
者不久复归阴矣。但疮原本于阴，其人多死。
痈疽发背如何医治？不论属于阴证还是阳证，首先要进行艾灸。如果患处不痛，就灸到出现痛感；如果患处疼痛，就灸到痛感消失。
凡是诊治痈疽在脑、项等部位发出的大疮，首先要从容镇定，确立治疗方案，以发病当天为第一天开始计算，到现在已经几天了。观察疮形与发病天数是否相符，相符则大多吉利，不相符则大多危险。其次要查看致病根源，病发于哪个脏腑，出于哪个身体部位。要看身体有上下的区别，部位有险易之分，通过形色辨别顺逆，通过精神判断有无正气。再看患者年纪老壮，气血盛衰，是发阴证还是阳证，毒邪深重还是浅表。一般来说，阳证容易治疗的多能存活，阴证难治疗的多会死亡。接着诊察脉象的虚实，可以知道病情顺逆，从而决定最终预后。凡疮疡未溃破之前，脉象要稍微有力（太过一二至）；已溃破后，脉象又宜稍弱（不及二三分），这叫脉象与病症相应，从头到尾自然没有变症。如果脉症相反，恐怕会有意外变故。但诊断的关键在于医生眼力精巧，用心体察，一一参详明白，表里透彻，然后才能确定治疗方法。凡疮疡七日以前，情势尚未形成，元气未弱，不论阴阳表里、寒热虚实，都应当先施灸法。轻症使毒瓦斯随火气而散，重症拔引郁积之毒，通达内外。火能引导毒瓦斯混合转化为阳，才能促使发肿作痛，然后才可以采用发汗、攻下、消散或托毒等方法，兼求标本同治，必须做到脉象与药物相合、药物与病症相合，这样治疗，自然就不会出错！所以用药难以拘泥成方，全在于灵活变通，大体上关节首尾，都不可以损伤元气脾胃，这是最重要的原则。
内服蟾酥丸一剂，外用神灯照三枚。
凡疮疡初起，七日以前，或者已经施灸之后，尚未服用其他药物时，适宜服用蟾酥丸一剂，若能出汗解表最为妙用。或者使用万灵丹发汗也可以，所谓毒瓦斯随汗液而散，是最为快捷的方法。如果服用这两种药后，仍然不出汗，这是因为表里闭塞紧密的缘故，毒邪也不轻，应当施用神妙拔根方进行治疗。神灯照法，也不可以应用得太早。如疮疡四五日之间，形态未聚拢，毒邪未外出，如果过早使用，恐怕留郁毒邪在内，毒邪反而难以排出。必须用在八九日之后，疮势已稳定，毒瓦斯已聚结，尚未化脓腐坏的时候。用此法照射，已成脓的自会高起，未成脓的自会消散，未溃破的自会溃破，未脱落的坏死组织自会脱落，这也是解毒活血、消肿散瘀的好方法。
用膏药贴敷在疮顶，用敷药围在四周。
凡疮疡最忌讳风寒侵袭。初起之时，或者已经施灸之后，都应当用太乙膏盖贴覆盖在疮顶，功效在于拔毒，提升疮顶和脓液，防御风寒侵入。如果疮疡高肿，阳疮七日之后，疮头自然会有黄色，稠脓粘附在膏药上，其余红肿红色光亮鲜明，每日宜用葱汤洗净，更换膏药贴敷。其正脓定在十一日前后流出，这属于容易治疗、容易安愈的症候。如果七日之后，疮不大肿高，四周又不疼痛，疮头也没有脓意粘附，这属于阴阳相等的症候。适宜用化腐紫霞膏，涂抹在疮顶上，外面用膏药覆盖。换药至十日外，疮顶逐渐腐烂，其余红肿逐渐高起，似有脓意的样子，其正脓只在十五日之后可流出，这属于由险转顺的症候。至于二十日以后仍无脓者，乃是纯阴之症，即使治疗也无效了。又如疮的四周围根脚余肿，其功效又在敷药，收束根本，使之不至于扩大。初起时宜用金黄散敷于四边，拔毒消肿止痛。既溃破后，当用铁桶膏箍束它，使疮根逐渐收紧。但各种疮疡的原因，都是气血凝滞而成，切不可纯用凉药，以免冰凝肌肉，多导致难以腐坏难以收敛，必须温暖，散滞行瘀，使用拔毒活血的药物，方才妥当。
气盛则疮顶自然高而突起，血盛则疮根脚束紧而无疑。
气血，是人原本禀赋的。老年人尚且可能有余，年轻人也可能不足。人的命脉，全赖于此。况且百病由此而生，失去它怎能没有变故，唯独外科尤其关系重大。但在肿疡阶段，如果没有正气冲托，则疮顶不能高肿，也不能疼痛溃破出脓；如果没有真阴相滋，疮根不能收束，颜色也不能红活收敛。凡疮顶高、根脚活络，不论老少，只要气血有余，都可以无妨。又宜界限分明，交会者，指疮根与健康肉交界之处，高低自然分别；明白者，指疮形与健康肉形，各自没有混杂。以此观之，了然明白了。
高肿起的，忌用攻利之药，以免损伤元气。平塌漫散的，适宜投予补托之剂，以益其虚损。
凡疮初发高起者，五脏内部原本没有深毒，毒发于体表，便得托里，以加速成脓，忌用内消攻伐之法，以免损伤脾气，脓反而难成，多导致不能溃破收敛。又疮初起不高不赤，平塌漫散者，元气本虚，急宜托里温中健脾，催托毒瓦斯向外发散。这样才没有变症。
内热严重的，酌情加入消毒清热的药剂。便秘干燥的，必须通利适宜。使脏腑得以宣通，使气血自然流利。
肿疡阶段内热口干，脉实烦躁，便秘喜冷者，此为邪毒在里，急与寒凉攻利，可选用内疏黄连汤、四顺清凉饮、内消沃雪汤。又兼有表症者，可用防风通圣散，去掉麻黄，或者双解散，加桔梗、天花粉；又或者小便不利者，兼入天水散、五苓散，都可合用。务必使二便通利，以杜绝病源。又有元气素来虚弱者，恐怕不能胜任前面的药物，可用托里消毒散，加蜜炒大黄，或者兼用猪胆导法，必须达到通利为止。治疗全过程都要保持闭而不结，通而不泄，使脏腑平和，表里透彻，方可托里排脓。内补的药物，如在溃疡阶段，虽然有口干便闭、脏腑不和不利等症状，这是因为溃破后脓水流出过多，体内津液亡失，气血虚耗，不能荣润脏腑所致。其人必然脉细而数，口和而干，饮食减少，喜欢喝热汤，这是虚阳之火为病，不是前面实证可比。只宜养气血，滋津液，和脏腑。这样治疗，则二便自然调和，也没有变症。常有误用攻利之法，多导致无法挽救的。
十日之间疮尚坚硬，必须用披针，当头点破。
凡疮十日以后，自然应当腐溃为脓，如果不作脓腐，仍然坚硬者，这属于阴阳相半的症候，疮根必然多深固，如果不将针当头点入寸许，开窍发泄，使毒瓦斯无从排出，必然导致内攻。倘若内部有脓，就容易排出，这是开户逐贼的意思。也有十日外，疮虽不腐溃，形态尚红活，热肿痛，这虽然脓迟，后来必然会有脓出，这又不必针刺。大概是因为元气不能充足，或者失于使用补托之药，又误用寒凉，或者覆盖保暖不够，多导致脓迟。有此症者，适宜用补中健脾、大补托的药，以得脓为有效。又以十五日至二十一日为期，超过这个期限之外，纵然有稀脓，但元气被毒邪抗拒，日久必然耗散，确实很难痊愈了。
半月之后脓也少，须用药筒，对着疮顶拔提，有脓血交粘，必然坏死肉容易脱落。
如疮半月后仍不腐溃，不作脓者，毒必内陷，急用披针品字样，在原疮顶寸许处，点开三孔，随疮之深浅，一寸二寸皆可入之，入针不痛，再深入不妨，随即用药筒预先煮热，对孔窍合之良久，候温取下。如拔出之物，血要红而微紫，脓要黄而带鲜，此为血气营运活疮，其人必然多活。又说脓血交粘，用药可全，色鲜红活，腐肉易脱。如拔出瘀血紫黑，色败气秽，稀水无脓者，此为气血内败死疮，所谓气败血衰，神仙也难救。这种疮难治，其人必然在月底死亡。
况且此时，内部有脓而不能向外发散者，以针钩向正面钩起顽肉，用刀剪，在原疮顶剪开寸余，使脓管得以通畅流动，使疮头无闭塞。
已用药筒拔脓之后，外部既有孔，内部窍道亦通。疮期又在大脓发泄之后，如脓尚少，也不是自然能得出，故疮头必有瘀腐涂塞，内部肉也有顽膜阻隔，多致脓管不通，自然难出。须用针钩起疮顶顽肉，以披针利剪，随便取去寸余顽硬之肉，取之微痛血出，都无妨碍，随即用两手轻重得宜，从疮根处，渐渐捺至中间，剪出脓管处，内有聚脓，自然涌出，以黄色稠浓为吉，其脓日渐多者为轻，反此为虑。此功务使涂塞者开之，令脓毒向外发散。
频繁用汤水清洗，切忌风吹。
凡疮未溃破前，或者已经用照药后，都要煎葱艾汤每日淋洗疮上一次，严重者早晚二次，使气血疏通，易于溃散。又已溃破时，及药筒提拔之后，尤其宜避风，先去旧药，用方盘疮下靠身放定，随用猪蹄汤以软绢淋汤疮上，并入孔内，轻手捺净内脓。使败腐宿脓随汤而出，以干净为度，再以软帛叠成七八重，勿令太干，带汤覆于疮上，两手轻盈旋按片时，帛温再换，如此洗按四五次，使气血得疏通，患者自然爽快，毒瓦斯得解，腐肉易脱，疼痛得减，这是手法的关键，大疮不可缺也。候腐脱已见红肉时，洗后随用红玉膏挑于手心捺化，搽新旧肉上，外用膏盖，四边根脚已消，不必箍药，每日如此，不数日，脓尽腐脱，新肉顿生。再加内补，调理得宜，轻疮只在月余，大疮不过七十日，必然收口而愈。
关节在于这个时候，变症产生于这个候期。
关节者，阳疮以十四日为关，阴疮以二十一日为节，这个时候务必使脓出势定，不可过度酝酿。但脓出方才自腐脱；腐脱方才自肌生，肌生方才自收敛，收敛方才自疮平。如这个时候不得脓者，后来必有变症，为一关顺，后来必多顺，一关逆，后来必多逆。
治疗应当大补，得以完成收敛之功，切忌寒凉，导致取变生之局。
凡疮溃破后，五脏亏损，气血大虚，外形虽然看似有余，而五脏内部不足，法当纯补，乃至多能存活。已溃破时发热恶寒，脓多自汗作痛者，用十全大补汤。虚热少睡，饮食不甘者，用人参汤。皮寒虚热，咳嗽有痰者，用托里清中汤。四肢倦怠，肌肉消瘦，面黄短气者，用人参养荣汤。脓多心烦，少食发躁不睡者，用圣愈汤。脾亏气弱，身凉脉细，大便溏泄者，用托里温中汤。饮食不甘，恶心呕吐者，用香砂六君子汤。脾虚下陷，食少虚热间作者，用补中益气汤。肾虚作渴，不能制约心火者，用加减八味丸。仿此选用，盖托里则气血盛而脾胃旺，使脓秽自排，毒瓦斯自解，死肉自去，新肉自生，饮食自进，疮口自敛。若不务补托，而误用寒凉，谓之真气虚而益虚，邪气实而益实，多致疮毒内陷，脓多臭秽，甚则脉洪大渴，面红气短，这是真气虚而死矣。
盖疮疡全赖脾土，调理必要端详。
脾为仓廪之官，胃为水谷之海。胃主司纳，脾主消导。一表一里一纳一消，营运不息，生化无穷。五脏六腑，借以生养，又谓得土者昌，失土者亡。盖脾胃盛者，则多食而易饥，其人肥胖，气血亦壮；脾胃弱者，则少食而难化，其人瘦削，气血亦衰。所以生命赖以安宁，疾病赖以安宁，何况外科尤其关紧要。善于调养脾胃者，节制饮食，调适寒暑，戒除喜怒，节省劳役。如果不这样，则精神气血由此而日渐亏损，脏腑脉络由此而日渐受损，肌肉形体由此而日渐削薄，所谓调理一失，百病生焉，故脾胃不可不详查。
冬天要温床暖室，夏天宜净几明窗。
人之气血，喜暖而恶寒，又谓遇寒则结，遇热则散。何况疮乃肌肉破绽之病，若不防御，风寒最为易袭。凡看疮时，冬天要围炉暖室，逼尽余寒。夏天宜净几明窗，使外风不入，然后方可揭膏洗贴。
饮食何须严格戒口，冷硬腻物休飧。
人之病中，肿痛时自然痛伤胃气，诸味不喜。直待溃破后，脓毒一出，胃气便回，方才欲思食。彼时但所喜者，便可与之，接补脾胃。如所思之物不与，此为逆其胃气，反致不能食也。切要不可太过，惟恐生冷伤脾难化，硬物肥腻滑肠，故禁之。
痈疽虽属外科，用药即同内伤。
古之以外科推为杂病之先，盖此伤人迅速，关系不浅，故特设于前也。且如痈疽脑项疔毒大疮，情势虽出于外，而受病之源，实因于内也。及其所治，岂可舍于内而治外乎？所以外不起者，内加托药；表热甚者，内必清解。血虚宜用四物汤，气虚宜用四君子汤，脉虚足冷温中，脉实身热凉膈。以此推之，内外自无互异。
病要论久新，要法在于宽治猛治。
病有新久，势有缓急。如受病之初，元气未弱，治当随症迎刃而解。若惧行霸道猛剂，定不能决效于危急时也。用药中病，如表症盛者，用万灵丹，大加表散。里症急者，以内疏黄连汤，急与通行。又如受病日久，邪正相拒，其元气示有不衰弱者，纵有余症杂症壤症，俱当先固其本，而后调之和之散之，使病气渐退，元气渐醒，饮食渐进，根本渐实，则余患再无不愈之理。
药必求标本，功莫别于先医后医，若一概之攻补，恐两途之误用。
物理皆有标本。而病之标本，尤莫切焉。身体之标本，五脏为本，六腑为标。五脏主里主血，六腑属表属气。疾病标本，以初病为本，以传病为标；又以元气为本，病气为标。此所以寒热表里缓急之病，应汗下补泻和解之方。凡治病者，必先治其本，后治其标。若先治其标，后治其本，使邪气滋甚，其病益增。又谓缓则治其本，急则治其标，假如先得疮疾，而后得泄泻呕吐食少等症，宜舍本从标之法治之，候泻止呕定食进，方再治疮，余皆仿此。
又说阳变为阴，内外被寒凉克伐。
疮本发于阳者，为痈为热为实为疼，此症易治。患者不觉，以为小恙，不早求治。反又外受风寒，内伤生冷，或再被医者失于补托，而又以凉药敷围，以图内消，合病家之意，多致气血冰凝，脾胃伤败，使疮毒变在十一日未出脓之前，情势与好肉相平，不疼不热，软慢相兼，疮孔止流清稀肥水，更兼身体不热，脉亦细微，饮食厌飧，精神昏短。有此症者，变入真阴，虽强投温中健脾之剂，不应者，百无一生。如疮变在十五日之后，已出脓时，毒瓦斯已将外发，如有调摄失宜，误食冷物，忽变为阴者，急投托里温中汤，十二味异功散，轻者十全大补汤，俱倍加参桂附以救之。须得疮热作痛，脓出身温，脉起食进者为吉。但疮原本于阳其人故得多生者有矣。
岂期阴变为阳，首尾得辛热扶衰，病分真似，理究阴阳。
疮本发于阴者，为疽为冷，为硬为虚，此症难治。患者知觉欲生，而故将辛香酒煎大方热药以助之，医者又欲患处高肿，热作脓，敷以热药，图其起发，故疮得药性大热，转阴为阳。其疮虽得微肿微热微痛微脓，但疮形终不似真阳红活，不得真浓黄脓，如此者不久复归阴矣。但疮原本于阴，其人多死。
How to treat carbuncles and sores on the back? Regardless of whether it is a Yin syndrome or a Yang syndrome, moxibustion should be performed first. If there is no pain, moxa until pain appears; if there is pain, moxa until pain disappears.
When diagnosing and treating large sores caused by carbuncles and sores erupting on the brain, neck, etc., one must first remain calm and establish a treatment plan. Count the days from the onset date to the present. Observe whether the sore's appearance corresponds with the number of days passed; correspondence indicates a favorable prognosis, while discrepancy suggests danger. Next, examine the source of the disease: which Zang-Fu organ is affected and which body part is involved. Consider the upper and lower body distinctions, the severity of the location, differentiate between favorable and unfavorable signs based on color and shape, and assess the presence of healthy Qi based on the patient's spirit. Also consider the patient's age (young or old), the strength or deficiency of Qi and Blood, whether it is a Yin or Yang eruption, and whether the pathogenic toxin is deep or superficial. Generally, Yang syndromes are easier to treat and more likely to survive, whereas Yin syndromes are difficult to treat and more likely to result in death. Then, palpate the pulse for excess or deficiency to determine the favorability or unfavorability of the condition and predict the final outcome. Before the sore ulcerates, the pulse should be slightly forceful (exceeding normal by one or two beats); after ulceration, the pulse should be slightly weak (deficient by two or three parts). This is called "pulse and disease corresponding," ensuring no unexpected changes occur from start to finish. If the pulse and symptoms contradict each other, unexpected complications may arise. However, diagnosis relies on the physician's sharp observation and mental attunement, thoroughly understanding the interior and exterior before determining the treatment method. For sores within seven days of onset, when the condition has not yet fully formed and healthy Qi is not yet weak, regardless of Yin/Yang, Interior/Exterior, Cold/Heat, or Excess/Deficiency, moxibustion should be applied first. For mild cases, it disperses the toxic vapors via fire; for severe cases, it draws out stagnant toxins and connects the interior and exterior. Fire guides the toxic vapors to transform into Yang, promoting swelling and pain, after which diaphoresis, purgation, resolution, or suppuration methods can be used. Treatment should address both root and branch, matching the pulse with the medicine and the medicine with the disease. Such treatment will naturally be error-free. Therefore, prescription cannot be rigid; flexibility is key. The most important principle is to avoid damaging Healthy Qi and the Spleen-Stomach at any stage.
Internally administer Chan Su Wan (Toad Venom Pill) once; externally apply Shen Deng Zhao (Divine Lamp Illumination) three times.
For newly erupted sores, before the seventh day, or after moxibustion but before taking other medicines, it is appropriate to take one dose of Chan Su Wan (Toad Venom Pill). Sweating is ideal. Alternatively, Wan Ling Dan (Ten Thousand Spirits Pill) can be used to induce sweating. As the saying goes, dispersing toxic vapors through sweat is the quickest method. If sweating does not occur after taking these two medicines, it is due to tight closure of the Exterior and Interior, indicating heavy toxicity. In this case, Shen Miao Ba Gen Fang (Divine and Wonderful Root-Pulling Prescription) should be used. Shen Deng Zhao (Divine Lamp Illumination) should not be used too early. Between the fourth and fifth day, if the shape has not gathered and the toxin has not emerged, early use may trap the stagnating toxin inside, making it harder to expel. It should be used only after the eighth or ninth day, when the sore's trend is stable, toxic vapors have gathered, and pus/necrosis has not yet formed. Using this method, formed abscesses will rise, unformed ones will dissipate, non-ulcerated ones will ulcerate, and non-detaching necrotic tissue will detach. It is also an excellent method for resolving toxins, invigorating blood, reducing swelling, and dispersing stasis.
Apply plaster to the top of the sore and wrap medicated poultices around the sides.
Sores are most susceptible to Wind-Cold invasion. At the initial stage, or after moxibustion, Tai Yi Gao (Great Emperor Plaster) should be applied to cover the top of the sore. Its efficacy lies in drawing out toxins, lifting the sore head and pus, and preventing Wind-Cold entry. If the sore is high and swollen, and after seven days of a Yang sore, the sore head naturally turns yellow with thick pus adhering to the plaster, and the surrounding redness is bright and shiny, wash daily with Scallion Decoction and change the plaster. The main pus will discharge around the eleventh day, indicating an easy-to-treat and safe condition. If after seven days the sore is not highly swollen, the surroundings are not painful, and the sore head shows no sign of pus adhesion, it is a condition where Yin and Yang are equal. Apply Hua Fu Zi Xia Gao (Rot-Decaying Purple Cloud Plaster) to the sore head and cover with plaster. After changing dressings beyond the tenth day, if the sore head gradually necroses and the surrounding swelling rises with signs of pus, the main pus will discharge after the fifteenth day. This is a condition turning from dangerous to favorable. If there is no pus after twenty days, it is a Pure Yin syndrome, and even treatment will be ineffective. Regarding the residual swelling at the base of the sore, the application of medicated poultices helps consolidate the root to prevent expansion. Initially, Jin Huang San (Golden Yellow Powder) should be applied to the sides to draw out toxins, reduce swelling, and relieve pain. After ulceration, Tie Tong Gao (Iron Bucket Plaster) should be used to bind the sore, helping the root tighten. Since all sores result from Qi and Blood stagnation, cool/cold medicines should never be used exclusively, as they may freeze the muscles, leading to difficulty in necrosis and healing. Warmth is required to disperse stagnation and move blood; using detoxifying and blood-invigorating herbs is appropriate.
When Qi is abundant, the sore head naturally rises and protrudes; when Blood is abundant, the root is consolidated without doubt.
Qi and Blood are the original endowments of humans. Even the elderly may have surplus, while the young may have deficiency. Human life depends entirely on them. Since all diseases arise from their imbalance, how can there be no changes if they are lost? This is especially critical in surgery. During the swelling stage, without sufficient Healthy Qi to support and lift, the sore head cannot become high and swollen, nor can it become painful and suppurate. Without True Yin to nourish, the root cannot consolidate, and the color cannot become red and lively. If the sore head is high and the root is lively, regardless of age, as long as Qi and Blood are sufficient, there is no cause for concern. The boundary should be clear: "Jiao Hui" (intersection) refers to the junction between the sore root and healthy flesh, where height differences are natural; "Ming Bai" (clarity) means the sore shape and healthy shape do not mix. Observing this makes things clear.
High and swollen sores should avoid purgative/diuretic drugs to prevent damaging Healthy Qi. Flat and spreading sores should receive tonifying and supporting agents to benefit deficiency.
For sores that initially erupt high, there is originally no deep toxin in the Five Viscera; the toxin is on the surface. Supporting the Interior accelerates pus formation. Avoid internal resolution and attacking methods to prevent damaging Spleen Qi, which would hinder pus formation and lead to failure in ulceration and healing. For sores that are initially neither high nor red, but flat and spreading, Healthy Qi is inherently deficient. Urgently support the Interior, warm the Middle, and strengthen the Spleen to urge the toxic vapors outward. This prevents complications.
For severe internal heat, add detoxifying and clearing agents according to measure. For constipation and dryness, ensure appropriate purgation. This allows the Zang-Fu organs to circulate freely and Qi and Blood to flow smoothly.
During the swelling stage, if there is internal heat, dry mouth, forceful pulse, irritability, constipation, and preference for cold, this indicates pathogenic toxin in the Interior. Urgently use cold and purgative methods. Options include Nei Shu Huang Lian Tang (Internal Dispersal Coptis Decoction), Si Shun Qing Liang Yin (Four Smooths Clearing and Cooling Drink), or Nei Xiao Wo Xue Tang (Internal Resolution Snow-Washing Decoction). If accompanied by Exterior symptoms, Fang Feng Tong Sheng San (Saposhnikovia Universal Benefit Powder) with Ephedrae Herba removed, or Shuang Jie San (Double Resolution Powder) with Platycodonis Radix (Jiegeng, 桔梗) and Trichosanthis Radix (Tianhuafen, 天花粉) added can be used. If urination is difficult, Tianshui San (Heavenly Water Powder) or Wu Ling San (Five-Ling Powder) can be combined. Ensure free passage of urine and stool to cut off the source. For those with inherent Healthy Qi deficiency who cannot tolerate the above, Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) with honey-fried Rheum Palmatum Rhizome (Dahuang, 大黄) or Pig Gallbladder enema can be used. The goal is free passage without leakage. Throughout treatment, maintain closure without blockage and openness without leakage, harmonizing the Zang-Fu and penetrating the Interior/Exterior, before supporting the Interior to drain pus. For internal tonification, in the ulceration stage, although symptoms like dry mouth, constipation, and Zang-Fu disharmony exist, these are caused by excessive loss of pus/fluid, leading to fluid depletion and Qi/Blood exhaustion, failing to nourish the Zang-Fu. The pulse is fine and rapid, the mouth feels normal but is dry, appetite is low, and hot drinks are preferred. This is Deficient Yang Fire, different from the Excess type mentioned earlier. Only nourish Qi and Blood, replenish fluids, and harmonize the Zang-Fu. This will naturally harmonize bowel movements and prevent complications. Misuse of purgatives often leads to untreatable conditions.
If the sore remains hard within ten days, it must be punctured with a lancet at the center.
After ten days, the sore should naturally necrose and suppurate. If it does not necrose and remains hard, it is a Yin-Yang half syndrome with a deep-rooted base. A lancet must be inserted about one cun into the center to open the orifice and vent the toxic vapors; otherwise, the toxin will attack internally. If pus exists inside, it will drain easily, following the principle of "opening the door to drive out the thief." However, after ten days, if the sore is not necrotic but remains red, lively, hot, swollen, and painful, pus may be delayed but will eventually appear, requiring no needle. This is due to insufficient Healthy Qi, failure to use tonifying/supporting herbs, misuse of cold herbs, or inadequate warmth. In such cases, use Spleen-strengthening and major tonifying/supporting herbs to achieve suppuration. The period from fifteen to twenty-one days is critical. Beyond this, even if thin pus appears, the Healthy Qi is repelled by the toxin and will eventually dissipate, making recovery difficult.
After half a month, if pus is scarce, use a medicinal suction cup to pull from the top. Pus-blood adhesion facilitates necrotic tissue detachment.
If after half a month the sore still does not necrose or suppurate, the toxin has sunk inward. Urgently use a lancet to make three holes about one cun apart at the top. Depth depends on the sore (one or two cun). Insertion should be painless. Heat the medicinal suction cup beforehand, place it over the holes for a long time, and remove when warm. If the extracted blood is red with slight purple and pus is yellow with freshness, it indicates circulating Qi and Blood in a living sore, suggesting survival. Fresh red color and easy detachment of necrotic tissue are good signs. If extracted blood is dark purple/black, with foul odor and watery pus, it indicates internal collapse of Qi and Blood in a dead sore ("Qi failure, Blood decline"). Such sores are difficult to treat, and death may occur by month-end.
If pus exists internally but cannot emerge, use a needle hook to lift stubborn flesh from the front, and cut open about one cun at the top with scissors to ensure patent pus ducts and prevent blockage.
After using the suction cup, external pores and internal channels are open. Following major pus discharge, if pus is still scant and not naturally emerging, it is likely blocked by necrotic debris or membranes. Use a needle to lift stubborn flesh at the top, and carefully trim about one cun of hard tissue with a lancet/scissors. Mild pain and bleeding are acceptable. Gently press from the base toward the center where the pus duct was opened. Accumulated pus will naturally surge out. Yellow, thick pus is auspicious; increasing volume indicates mildness; the opposite is concerning. The goal is to clear obstructions and allow toxic pus to discharge externally.
Frequently wash with decoction; strictly avoid wind exposure.
Before ulceration, or after lamp illumination, boil Scallion and Mugwort Decoction to wash the sore once daily (twice for severe cases) to promote Qi/Blood circulation and facilitate ulceration. After ulceration and suction cup treatment, wind avoidance is crucial. Remove old dressings. Place the patient comfortably. Wash the sore and insert soft cloth soaked in Pork Trotter Decoction into the hole, gently pressing out internal pus. Let decayed pus exit with the water until clean. Cover with folded soft cloth (7-8 layers), not too dry, keeping it warm with the decoction. Press gently for a moment, replace when cooled. Repeat 4-5 times. This promotes Qi/Blood circulation, relieves patient discomfort, resolves toxins, detaches necrotic tissue, and reduces pain. This manual technique is essential for large sores. When red meat appears after necrotic detachment, apply Hong Yu Gao (Red Jade Ointment) rubbed in the palm onto new and old flesh, cover with plaster. Once the base swelling subsides, binding paste is unnecessary. Daily care leads to complete pus/necrotic tissue clearance and rapid new flesh growth within days. With internal tonification and proper care, mild sores heal in a month, large sores in seventy days.
The critical junctures lie at this time; complications arise from this phase.
The "Guan" (pass) for Yang sores is fourteen days; the "Jie" (node) for Yin sores is twenty-one days. At this time, pus discharge must stabilize; do not delay excessively. Pus discharge leads to necrotic detachment, which leads to muscle regeneration, which leads to contraction, which leads to flattening. Failure to produce pus at this stage predicts later complications. One favorable pass leads to mostly favorable outcomes; one unfavorable pass leads to mostly unfavorable outcomes.
Treatment should focus on major tonification to achieve contraction; strictly avoid cold/herbals that cause complications.
After ulceration, the Five Zang organs are damaged, and Qi/Blood are severely deficient. Although the exterior seems robust, the interior is lacking. Treatment must be purely tonifying to ensure survival. For fever/chills, profuse pus, spontaneous sweating, and pain after ulceration, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). For deficient heat, insomnia, and poor appetite, use Ren Shen Tang (Ginseng Decoction). For cold skin, deficient heat, cough with phlegm, use Tuo Li Qing Zhong Tang (Support Interior Clear Middle Decoction). For limb fatigue, muscle wasting, sallow complexion, and shortness of breath, use Ren Shen Yang Rong Tang (Ginseng Nourishing Grace Decoction). For profuse pus, irritability, poor appetite, restlessness, and insomnia, use Sheng Yu Tang (Holy Recovery Decoction). For Spleen deficiency, Qi weakness, cool body, fine pulse, and loose stools, use Tuo Li Wen Zhong Tang (Support Interior Warm Middle Decoction). For poor appetite, nausea, and vomiting, use Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). for Spleen Qi sinking, poor appetite, and intermittent deficient heat, use Bu Zhong Yi Qi Tang (Tonify Middle Augment Qi Decoction). For Kidney deficiency causing thirst and inability to control Heart Fire, use Jia Jian Ba Wei Wan (Modified Eight Flavor Pill). Select accordingly. Supporting the Interior strengthens Qi/Blood and Spleen/Stomach, allowing pus/toxins to discharge naturally, necrotic tissue to fall, new flesh to grow, appetite to return, and wounds to close. Failure to tonify/support and misuse of cold herbs leads to "True Qi deficiency worsening, Pathogenic Qi excess worsening," causing toxin sinking, foul pus, forceful pulse, thirst, red face, and shortness of breath, resulting in death from True Qi exhaustion.
Sores rely entirely on Spleen Earth; regulation requires careful attention.
The Spleen is the Official of Granaries; the Stomach is the Sea of Water and Grain. The Stomach governs reception; the Spleen governs digestion. Exterior/Interior, Reception/Digestion operate continuously, generating infinite transformations. The Five Zang and Six Fu organs rely on them for nourishment. "Gain Earth and prosper; lose Earth and perish." Strong Spleen/Stomach leads to increased appetite, weight gain, and robust Qi/Blood. Weak Spleen/Stomach leads to poor appetite, indigestion, emaciation, and depleted Qi/Blood. Life and health depend on this, especially in surgery. Those who nurture Spleen/Stomach regulate diet, adjust to temperature changes, control emotions, and conserve energy. Neglect leads to daily depletion of Spirit/Qi/Blood, damage to Zang-Fu/Meridians, and wasting of muscles/form. "One mistake in regulation breeds a hundred diseases." Thus, the Spleen/Stomach must be carefully managed.
In winter, keep beds and rooms warm; in summer, keep desks and windows clean and bright.
Human Qi and Blood prefer warmth and dislike cold; cold causes coagulation, heat causes dispersion. Sores involve broken muscle/flesh, making them vulnerable to Wind-Cold if unprotected. In winter, use stoves to warm rooms and dispel residual cold. In summer, keep environments clean and bright to exclude external wind before removing plaster, washing, or reapplying dressings.
Dietary restrictions need not be extreme; avoid cold, hard, and greasy foods.
During pain and swelling, Stomach Qi is injured, and appetite declines. After ulceration, once pus/toxins discharge, Stomach Qi recovers, and hunger returns. At this point, provide desired foods to support the Spleen/Stomach. Denying desired food reverses Stomach Qi and causes anorexia. However, avoid excess. Raw/cold foods injure the Spleen and are hard to digest; hard/greasy foods lubricate the intestines excessively. Hence, they are prohibited.
Although carbuncles/sores belong to Surgery, medication is similar to Internal Medicine.
Ancients considered Surgery prior to miscellaneous diseases because it harms rapidly and is significant. Carbuncles/sores on the head/neck, despite external presentation, originate internally. Treatment cannot ignore the interior. If external eruption fails, add internal supporting herbs; if Exterior heat is severe, clear and resolve internally. Blood deficiency uses Si Wu Tang (Four Substances Decoction); Qi deficiency uses Si Jun Zi Tang (Four Gentlemen Decoction). Weak pulse/cold feet require warming the Middle; forceful pulse/fever require cooling the Chest. By analogy, Interior and Exterior treatments are consistent.
Disease duration determines strategy: gentle vs. aggressive treatment.
Diseases vary in novelty and urgency. Early stage with intact Healthy Qi allows symptom-specific resolution. Fear of using strong/potent agents prevents effectiveness in crises. Medication must hit the target. For strong Exterior symptoms, use Wan Ling Dan (Ten Thousand Spirits Pill) for heavy diaphoresis. For urgent Interior symptoms, use Nei Shu Huang Lian Tang (Internal Dispersal Coptis Decoction) for rapid purgation. For long-standing disease with resisting Pathogen and Healthy Qi, even with residual/mixed symptoms, first consolidate the Root, then harmonize, resolve, and disperse. This gradually retreats pathogenic Qi, restores Healthy Qi, improves diet, and strengthens the foundation, ensuring cure of remaining issues.
Medication must seek Root and Branch; distinction lies in treating Root first, then Branch. Uniform attack/tonification risks misuse.
All things have Root and Branch. Disease Root/Branch is critical. Body Root/Branch: Five Zang are Root, Six Fu are Branch. Zang govern Interior/Blood; Fu govern Exterior/Qi. Disease Root/Branch: Initial illness is Root, transmitted illness is Branch; Healthy Qi is Root, Pathogenic Qi is Branch. Thus, cold/heat, interior/exterior, urgent/chronic conditions correspond to diaphoretic, purgative, tonifying, draining, or harmonizing formulas. Treaters must treat Root first, then Branch. Treating Branch first exacerbates Pathogen and worsens disease. "Chronic conditions treat Root; acute conditions treat Branch." For example, if sore disease precedes diarrhea/vomiting/poor appetite, treat Branch (digestive symptoms) first. Once diarrhea stops, vomiting ceases, and appetite returns, treat the sore. Others follow this pattern.
Yang transforming into Yin results from internal/external cold/cool suppression.
Sores originating in Yang are carbuncles, heat, excess, and pain—easy to treat. Patients may ignore them as minor ailments and delay treatment. External Wind-Cold or internal raw/cold injury, combined with physician failure to tonify/support and use of cooling compresses for internal resolution, aligns with patient desires but often causes Qi/Blood freezing and Spleen/Stomach damage. If transformation to Yin occurs before the eleventh day (before pus), the sore becomes level with healthy flesh, painless, non-hot, soft/slow, draining clear/watery fluid. Body is not hot, pulse is fine/small, appetite is poor, spirit is dull. This enters True Yin. Even strong warming/Spleen-strengthening agents fail; mortality is nearly 100%. If transformation to Yin occurs after the fifteenth day (after pus discharge), with improper care or cold food ingestion, urgently use Tuo Li Wen Zhong Tang (Support Interior Warm Middle Decoction), Shi Er Wei Yi Gong San (Twelve-Ingredient Extraordinary Function Powder), or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) for mild cases, doubling Ginseng, Cinnamon Twig, and Aconite Root to save the patient. Auspicious signs include sore heat/pain, warm body after pus discharge, rising pulse, and improved appetite. Originally Yang sores often survive.
Unexpectedly, Yin transforming into Yang requires pungent/warm herbs to support decline throughout; distinguish true/false, investigate Yin/Yang principles.
Sores originating in Yin are ulcers, cold, hardness, and deficiency—difficult to treat. Patients desire life and may self-administer large doses of pungent/aromatic wine-decocted hot herbs. Physicians may also apply hot compresses to induce swelling/hotness/pus. The sore receives intense heat, transforming Yin to Yang. The sore may show slight swelling/heat/pain/pus, but the shape lacks the red/lively quality of True Yang, and pus lacks true thick yellow consistency. Such sores soon revert to Yin. Originally Yin sores often result in death.